Hospitals And Clinics Fear Cuts In Medicaid Under Trump

As the future of Obamacare hangs in the balance, the chief medical officer for Hartford Healthcare says that scaling back the Medicaid part of the law would mean a loss of "tens of millions of dollars" in revenue and would result in staff reductions and scaling back of services.

Dr. Rocco Orlando, chief medical officer for the Hartford Healthcare system, said the hospital's leaders are very concerned about the prospect of the federal government no longer paying the vast majority of the cost of expanding eligibility for Medicaid.

"It would have profound impact; it's very much front of mind," he said.

He's assuming Connecticut could not cover the cost of about 200,000 people who were able to get covered under Medicaid after the law broadened eligibility for the public health insurance.

This year, Connecticut will need to come up with about $61 million for a Medicaid expansion that was part of Obamacare, which is also known as the Affordable Care Act.

But the bill that could come due in 2019 or 2020 if Obamacare is repealed is far more significant. Currently, the federal government pays 98 percent of the $1.2 billion annual cost to insure 201,000 poor adults in Connecticut who used to make too much to qualify for Medicaid. Under Obamacare, the federal share was going to gradually shrink until it was a 90 percent match — far more generous than the 50 percent match Connecticut receives for another 555,000 residents covered by Medicaid.

"The [Affordable Care Act] expanded coverage to a significant number of individuals; this expansion was funded in part through cuts to Medicare payments to hospitals," the Connecticut Hospital Association said in a statement. "If the law is repealed and the cuts remain in place, Connecticut hospitals' fiscal stability and sustainability, as well as patient access to care, will be compromised."

Vice President-elect Mike Pence recently promised to repeal Obamacare "lock, stock, and barrel" early next year, but congressional leaders are saying there will be a two- or three-year transition period before the health bill's replacement takes effect.

"My sense is there'll be a little breathing room. I think there will be a public repeal in January, but I believe they're going to be prudent enough to delay implementation for anything for two years or three years," Orlando said.

Orlando said Hartford Healthcare's five acute care hospitals, two mental hospitals and myriad outpatient programs would not be affected much by disruption in the individual private insurance market. But they are very concerned about the prospect of tens of thousands of people losing Medicaid coverage.

Hospitals have seen a reduction in uncompensated care since Obamacare rolled out. At Meriden's MidState Medical Center, Hartford Healthcare's location with the most significant number of uninsured patients, the proportion of uninsured patients fell from nearly 2.5 percent to barely more than 1 percent.

At the Hospital of Central Connecticut, the cost of uncompensated care fell from $10.7 million in Fiscal 2013 to $6.1 million in Fiscal 2015.

Capping Medicaid?

Dr. Tom Price, President-elect Donald Trump's selection to lead the Department of Health and Human Services, which oversees Medicare, Medicaid and Obamacare, would like to move from a guarantee of health care to the poor to a set amount of spending per person. Instead of sharing the cost of nursing home or hospital bills with states, the government would send a block grant and let the states sort it out.

Orlando said his colleagues are concerned about this approach, "particularly if the move to block grant has an agenda to reduce Medicaid."

They're not remaining silent about their concerns, either. He said they're "very actively engaged in providing input" to Congress about what they want an Obamacare replacement to preserve.

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"Regardless of your party affiliation, there are elements of the ACA that warrant ongoing support," he said.

He acknowledged that Medicaid does not have the same kind of bipartisan support as some more popular parts of the law. Price wrote a letter last year that said that Medicare, Medicaid and Social Security "are binding seniors and low-income families to a costly, centralized health care strategy that intrudes on the personal decisions of patients and their doctors; promising retirement income the government cannot provide; trapping the disadvantaged in a web of welfare programs that draw beneficiaries into long-term government dependency."

Bills for about half of all patients in nursing homes are covered by Medicaid. Some were not poor until the cost of long-term care wiped out their savings.

And, Price's letter said the open-ended commitment approach of these programs is unsustainable, and will require "enormously higher taxes" in the future.

These clinics, such as Community Health Services on Albany Avenue, get more than half of their revenue from Medicaid. Only 8 percent of their bills are paid through private insurance — generally for people who cycle on and off of Obamacare and Medicaid as their hours fluctuate during the year.

Until last year, the centers received about $4 million a year in state funding, but with the budget crisis, that's no longer available.

Deb Polun, director of government affairs and media relations for the Community Health Center Association of Connecticut, said even though the arrival of Obamacare didn't increase the number of customers, she and her colleagues are worried that if insurance is pulled from thousands of clients, they'll stop coming in for care.

She said doctors and nurses will tell them: "Don't worry, you can still come here, we'll see you," but many patients feel guilty if they don't have the $25 fee for the visit.